Combination T4/T3 Treatment for Hypothyroidism?

Some patients with hypothyroidism report feeling better when they take both levothyroxine (T4) and triiodothyronine (T3) than when they take T4 alone, but published evidence supporting combination therapy is mixed. For this trial, Italian researchers enrolled 141 patients who had undergone total thyroidectomy for benign or malignant disease and who had been on stable T4 replacement therapy. They were randomized to receive either daily T4 alone or daily T4 plus twice-daily T3 — with appropriate placebos to preserve blinding. Doses were adjusted (by clinicians not involved with the participants) to maintain normal thyroid-stimulating hormone (TSH) levels; for patients who received combination treatment, additional adjustments targeted a physi…